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A longitudinal examination of how hospital provision of home health services changed after the implementation of the Balanced Budget Act of 1997: Does ownership matter?

机译：纵向审查了1997年《平衡预算法》实施后医院提供的家庭医疗服务的方式：所有权重要吗？

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摘要

By using a natural experiment approach and longitudinal national hospital data, this study sheds light on the objective functions of hospitals with different ownership forms by comparing their relative reductions in HH provision after the implementation of the BBA. The empirical findings reveal that for-profit hospitals behave differently as compared to public and private nonprofit hospitals, due to their different operational objectives. While the response of for-profit hospitals is consistent with the profit-maximizer model, both public and private nonprofit ownership types behave consistently in accordance with the model of two-good producers whose objective is to maximize market outputs for meeting the health care needs of the community, given the break-even requirement. This finding provides support for the tax exemption the United States government has granted private nonprofit hospitals.;Although the response patterns of the nonprofit ownership types are in general similar, this study found that, contrary to expectation, religious hospitals were more likely than secular nonprofit hospitals to have reduced HH provision after the BBA. Further studies are needed to explore the difference in operational behaviors between these two ownership types.;Built on previous related studies and applying a more comprehensive set of independent and control variables with improved data sources, this study is able to examine the effects of certain organizational and market factors on hospital offering of HH care pre-BBA and the change in the provision of HH care in the six years following the implementation of the BBA. Hospital proportion of Medicare patients, hospital size, total profit margin, case mix index, elderly density in the market are found to be positive determinants of a hospital's likelihood of offering HH care. However, these organizational and market factors, in general, play a non-significant role in influencing hospitals' changes in HH care provision after the implementation of the BBA. In the study, explanations and implications of these finding are discussed. Finally, potential limitations to this study and opportunities for future research are addressed.
机译：通过使用自然实验方法和国家医院纵向数据，本研究通过比较实施BBA后相对所有制减少的HH提供量，揭示了不同所有制形式的医院的客观功能。实证结果表明，与营办性和非营利性医院相比，营利性医院的行为因其不同的经营目标而有所不同。虽然营利性医院的反应与利润最大化模型相一致，但公立和私营非营利组织所有权类型的行为均符合两种商品生产者的模型，其目的是最大化市场产出以满足医疗保健需求。社区，考虑到收支平衡的要求。这一发现为美国政府已授予私人非营利性医院的免税提供了支持。尽管非营利性所有制类型的响应模式总体上相似，但该研究发现，与预期相反，宗教医院比世俗性非营利性医院更有可能BBA之后医院减少了HH的提供。需要进一步的研究以探索这两种所有权类型之间的操作行为的差异。；基于先前的相关研究，并应用具有更完善数据源的更全面的独立和控制变量集，该研究能够检验某些组织的影响实施BBA后的六年内，医院提供HH护理的市场因素以及市场变化以及HH护理服务的变化。市场上发现Medicare患者的医院比例，医院规模，总利润率，病例混合指数，老年人密度是决定医院提供HH护理可能性的积极因素。但是，总体而言，这些组织和市场因素在实施BBA后对医院的HH护理服务变化产生影响方面起着不重要的作用。在研究中，讨论了这些发现的解释和含义。最后，解决了这项研究的潜在局限性和未来研究的机会。

著录项

  • 作者

    Chou, Tiang-Hong.;

  • 作者单位

    Virginia Commonwealth University.;

  • 授予单位 Virginia Commonwealth University.;
  • 学科 Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2009
  • 页码 227 p.
  • 总页数 227
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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